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Monday, September 28, 2015

New Study: RS2 and gut inflammation in Malawian children.

Finally, a study showing that Resistant Starch Type 2 is not the "wonder drug" that I have promoted for nearly three years now. Did RS2 cause gut inflammation in rural Malawi children?

It's been too easy, what with study after study for over 30 years showing that RS has profound effects on the gut biome and health of the habitual user. Let's take a look at this latest study and see if we should all immediately halt the use of RS2.

Too long? Don't wanna read? : RS2, as found in raw potato starch, banana flour, and Hi-Maize corn starch is a great prebiotic and can be used as a supplement for fiber in a healthy diet!

In this study, researchers were examining ways to reduce the massive stomach inflammation common in 18 undernourished, stunted growth, 3-5 year old Malawi children. They gave the kids 2TBS of RS2 per day for 2-4 weeks and concluded that it just did not help.

The reason these researchers chose RS2 as an intervention? In their words:

Resistant starch (RS) type 2 is present in cereals, tubers, legumes, and fruits. In animal models, consumption of RS improves gut integrity and
absorption of nutrients and reduces T cell infiltration of the mucosa.
In humans, the consumption of RS changes the composition of the
microbiota and promotes the microbial fermentative production of
short-chain fatty acids (SCFA), which putatively reduce gastrointestinal
inflammation. RS also improves symptoms and reduces pathology in inflammatory bowel disease.
In addition, RS meets the criteria for safety, durability, and
availability as a dietary intervention to reduce EED [chronic gut inflammation]. Administration of
an RS during an acute attack of diarrhea reduces duration of diarrhea in
adults with cholera and children. These data compel an examination of RS as an agent to reduce EED.

Indeed, RS2 has been shown to do some seemingly miraculous things that all emanate from the gut.

Why, then, did it not help these young children, severely malnourished, with EED (chronic gut inflammation)?

Mandasis

The intervention diet consisted of "spiking" the kids normal food with about 2TBS of Hi-Maize corn starch (HAMS). A "mandasis" is a donut-like food, these kids typically eat one per week.

During the intervention, the kids were given two mandasis per day for two weeks. They must have been in heaven!

Yum, yum. These sound delicious, although I prefer not to deep-fry my sugar and flour.

The Results (Were they Bad?)

All of the kids had an increase in Lactobacillus, which is normally considered the gold-standard for children's gut health. However, certain markers for gut inflammation did not decrease. Fecal Calprotectin was used as the marker for inflammation. This marker increased slightly, but was "not accompanied by any clinical manifestations."

Changes seen in the gut flora, short-chain fatty acid, pH, and all that were present. Some deemed "good" some deemed "bad." The researchers admit many, many limitations to their study:

Limitations of this study are that fecal sampling on either the habitual
diet or after the addition of RS were made at a single point in time.
Perhaps a more complete picture of the changes could be seen for a
series of samples collected from each subject. No placebo arm was
included, so that any temporal changes that occurred during the 4-week
study were not controlled for natural changes in the gut microbial
composition in this age group. A limitation of the data analyses was
that the microbiome before and after consumption of RS was compared with
LEfSe, a software that does not account for the paired nature of the
specimens. This results in a loss of statistical power to detect
differences.

MY Impressions?

If you ask me, this study is more about WHEAT than resistant starch! These kids' normal diet?:

The children consumed a plant based, predominantly maize diet, with an animal source food.

The "animal source food" was less than 4g per day! These kids were eating almost nothing but CORN prior to the donut orgy the researchers brought to town.

More than likely, these kids were already on a high RS diet, yet severely malnourished and starving for animal nutrients. It's well-known that the corn served in these areas is often as "stale maize porridge" high in RS and normally protective of gut problems for the rural Africans who can manage to stave off malnutrition.

Bottom line, this study replaced a bit of corn with a LOT of flour. Fried in oil, no less.

This study was designed to test an RS intervention on severely malnourished, stunted pre-schoolers. The researchers did a terrible job feeding these kids during the intervention diet. The intervention proved to be not helpful in reducing markers of inflammation.

Conclusion

RS is a great prebiotic! Use Hi-Maize or Raw Potato Starch as a supplement if you feel you need more fermentable fiber in your diet. Just please, not like this:

This was a kind of cool study. The researchers were so impressed by the possibilities that Hi-Maize could help these kids, they did an experiment: "Will the simple addition of some HAMS help?" The answer, no.

These kids are the typical, bloated, starving African kids you see covered in flies. It would have been cool if a bit of HAMS helped them.

Hi. When last I commented you were trying the organic frontier brand PS. The link on this is to Anthony's organic brand, which is much cheaper. So is this the new recommended brand? And wow, soybean and refined flour...

I will order Anthony's next time I need some. I'm not a stickler for brands. Bob's Red Mill is still OK in my book, too, just not "organic". But the price on Anthony's Organic is the same as Bob's non-organic.

I agree with Tim, this was simply a bad study design. I have been taking 2TBS of Bobs red mill PS for over a year. I cant begin to tell how glad I am to discover this blog. I never got a ubiome test, but I went from hard and smelly to soft and no smell. By hard I mean like cement, was in hospital twice for impacted feces. By soft I mean I can go without straining and very regular for fisrt time since my teens. Clearly something good going on. I'm not even tempted to try anything else. I don't eat as good as I should, but the PS seems to completely make up for occasional messups like McDonalds and cookies. Jerry

Glad it's helping. It's comments like this that keep me going. I see first-hand in my small circle of family and friends that the simple addition of a couple scoops of raw potato starch is so helpful to people with long-term digestive issues.

Some day, RS will get the attention it deserves, until then, I will just keep talking about it and keeping up with the research and new papers.

Wow Jerry, that is so dramatic! You are like one of my patients who early on, way back when Tim was contributing to Richard's blog, I suggested using potato starch. She was already using metamucil to no effect and was convinced she had a psychological problem. She's been using the potato starch consistently since then and says it's saved her life. She has tried to go off it for a few days here and there with adverse consequences. All good.

Mazmanian’s group found that when an antibacterial drug or infection starts to wipe out the bacterial settlements, the microbes hide away in colonic crypts with the help of the ccf genes. Once the trouble clears, the reservoirs of microbes emerge and repopulate the gut ecosystem.

Jo tB! That was a great link! Thank you! (Tim--links don't work for me. Is it my browser? Maybe I need to switch browsers. Or are other people having this problem too? I may try a different browser next time, as I'm also having trouble getting this comment left. Thanks for the post on the study, too. Not a good study for us to determine much.)

"The diet of dried plums helped to change the levels of two of the major phyla of bacteria inside the gut. In addition, within the distal colon it increased the amount of Bacteroidetes, but lowered the number of Firmicutes. In the proximal colon, proportions were unaffected."

Wonder what effect dried Turkish figs have. I know they healed my (TMI alert) anal fissure. Had it for 2 years. Exquisitely painful. Never mind the metamucil and all the blah blah from the useless bum specialist. One day I saw them at the grocery store and since I really like figs, I ended up free basing them for 2 weeks and a miracle happened. That was back in 1997. Haven't had a recurrence since.

I think they have everything: soluble fibre, insoluble fibre, sugar alcohol and magic! There's magic in them figs.

This answers the question I had for Tim! We are coming to the end of the organic blueberry / blackberry season. I'm am still eating the concoction of PS, oat bran, and berries daily in a bit of raw milk. I love it and I was wondering how to replace the berries for the winter. Frozen berries are good in liquids but I enjoy eating this stuff in a bowl. I think I'll throw in a few organic prunes, would that be good?

I understood the term "free basing." I got into them for a while. Good, good stuff! I'll probably start eating more when there are fewer fresh fruits around. I also like dates, but they are not as addictive.

Shh, nowadays if I eat them I squish them down, cut them in half, smear La Vache Qui Rit (Laughing cow cheese) inside and close the fig down like a cookie or sandwhich. YUM! I guess cream cheese would be just as good. A snack that keeps a person going in more ways than one. ;)

Yaelle, Gabi - I have tried the blueberries in "one of those dryer things" and it resulted in inedible pebbles. What a waste. Commercially dried are way better. But apples, now that's a dried fruit anyone can make. Even in a cheapo dehydrator like mine they turn out really well.

Nicole - Yes! They're so good that way! Does she serve them with cream?

I've seen the recommendation to put coconut milk in rice a couple of times to increase the RS content. I tried it a couple of weeks ago and it was great. I tried it again the other day with a much more condensed coconut cream and the result has been inflammation and feeling not too great. I can't think what else I've changed recently, so it has to be the stronger coconut product.Does anyone have a sense of what might be going on? I guess the answer is simply gut dysbiosis, but thought I'd ask the experts here as well.

If it is condensed it could have a higher fat content than you might be used to or more coconut meat. And it depends on what your gut can handle at any one time. Additives (if they are stated on the can) can differ between brands, so that might be something to watch for..

Is this really true? http://www.npr.org/sections/thesalt/2015/09/19/441494432/the-u-s-doesnt-have-enough-of-the-vegetables-were-supposed-to-eat

I went to Walmart today because I needed potting soil Imagine: Walmart sells the best potting soil and it's a Canadian product. But the Canadian Tire store sells, ahem, American crappy potting soil.... but I digress. Usually I shop at the Chinese supermarket or the Korean. Or even the Italian. Lots and lots of all sort of vegetables for sale and all sorts of fruit. Walmart? Clearly a tokenism of fresh fruit and veg compared to the huge huge HUGE amounts of crap in a bag lining aisle after aisle. Huge display of bananas for 57 cents a pound. Greenish tomatoes.

The Chinese supermarkets have probably over 200 fresh items. At least.

So if Walmart if typical of what American shoppers are seeing, then yeah, can well believe that Americans just don't have sufficient fresh veg and fruit available and not much variety.

The drug in this case seems to be a good choice, but I'm sure there are plenty of downsides as well:

https://en.wikipedia.org/wiki/Ebselen

Ebselen or 2-phenyl-1, 2-benzisoselenazol-3(2H)-one (also called PZ 51 or DR3305), is a mimic of glutathione peroxidase and can also react with peroxynitrite.[1] It is being investigated as a possible treatment for reperfusion injury and stroke,[2][3] hearing loss and tinnitus,[4] and bipolar disorder.[5][6]

Additionally, ebselen may be effective against Clostridium difficile infections.[7]

Ebselen is a potent scavenger of hydrogen peroxide as well as hydroperoxides including membrane bound phospholipid and cholesterylester hydroperoxides. Several ebselen analogues have been shown to scavenge hydrogen peroxide in the presence of thiols.[8]

Ebselen seems to wipe out gram positives, but not negatives. That should wipe out all of the gut bacteria responsible for triggering development of the immune system. Wiping out C. diff - like bacteria is a very bad thing. Wiping out inflammation is also very bad. Look at the side effects of TNF-targeted antibodies. Ebselen looks like a great drug for medical emergencies and terrible for healthy people. Daily drug use is always a health compromise and BTW, is the actual cause of superbugs, the target of Ebselen. Thus, broad use of drugs/antibiotics like Ebselen, should contribute to the superbug, multi-antibiotic resistance problem.

Funny, but I was just mulling over this exact thought. Why is junk food so bad? A junk food meal itself is probably OK as long as the other food you've eaten that day is vegetable-rich and gut friendly. It's the non-stop eating of this stuff several times a day that's really bad.

And, too, even at fast-food places, there's a gradient of food choices. Chicken Nuggets and other wheat-breaded, deep-fried foods being the worst. But rest-assured all food in a fast-food joint is somehow "engineered" to make us want more. Probably even the smells and decor of a fast-food restaurant all designed with sales in mind.

I like this from the link:

"We are unlikely to stop people eating fast food, but the devastating effects on our microbes and our long term health could possibly be mitigated if we also eat foods which our microbes love like probiotics (yogurts), root vegetables, nuts, olives and high-fibre foods. What they seem to crave, above all else, is food diversity and a slice of gherkin in the burger just isn’t enough."

These stunted children already suffered poor diet and poor sanitation causing Proteobacteria overgrowth known from previous research about Malawian kwashiorkor. So, I wasn't surprised to learn Proteobacteria didn't increase with prebiotic intervention. However, this was troubling: "The most upregulated pathway with the addition of RS to the habitual diet was lipopolysaccharide biosynthesis (Fig. 2)."

These kids were not in "heaven" from the additional donut diet as you suggest. And it's not a simple matter of wheat and omega-6 fats. The prebiotic upregulated inflammatory LPS, likely in the small intestine. This also explains why RS2 can cause problems in people who already suffer gram-negative LPS-producers in SIBO.

By the way, have you ever tried or research rice bran? Really interesting stuff.

FIFA 16 is an association football simulation video game published by EA Sports for Microsoft Windows, PlayStation 3, PlayStation 4, Xbox 360, Xbox One, Android and iOS. The game is the first in the FIFA series to include female players.

About Me...

This is the blog of Tim Steele. I live in North Pole, Alaska...a small town near Fairbanks and just a stone's throw from the Arctic Circle. I've spent the last several years toying with and talking about numerous health interventions such as:

I use all of these simple interventions to stay healthy and lean. Having recovered from full-blown metabolic syndrome, I think that most people can cure themselves of most of their health problems with a focus on dietary and lifestyle choices.

I'm a 21 year US Air Force veteran with a background in electronics, water treatment, industrial controls, power generation, and science. I presently work in a hospital as the Electrical Systems Supervisor. I'm also pursuing a Master's Degree in Biotechnology through the University of Maryland.

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